Feasibility and acceptability of hepatitis C virus self-testing models among high-risk groups in Nasarawa, Nigeria; exploratory cross-sectional analysis of an implementation study

Abstract Background Hepatitis C virus (HCV) infection remains a major public health challenge, with significant gaps in diagnosis and treatment in resource-limited settings. Hepatitis C self-testing (HCVST) offers a potential strategy to expand access, particularly in HIV clinical settings. We evaluated feasibility and acceptability of HCVST among high-risk populations in Nasarawa State, Nigeria when provided at antiretroviral (ART) clinics and one-stop shops (OSS) serving key populations (KP). Methods 2,000 participants were enrolled between May 2023 and December 2023. Participants tested with either blood-based or oral fluid HCVST, and with or without health worker support. Follow-up documented results and linkage to qualitative RNA PCR testing and treatment. Feasibility was assessed across the HCV care cascade using chi-square tests. Acceptability was evaluated using a post-test survey score derived through factor analysis; associations between low acceptability (lowest 10%) and participant characteristics were explored through regression analyses. Outcomes were compared by facility type (ART clinic vs. OSS). Free-text responses were thematically analyzed to contextualize findings. Results HCVST was feasible and acceptable. Of 226 reactive HCVST results (11.3%), 99.1% received RNA PCR testing. Among those with detectable RNA, 92% initiated treatment and 97% completed therapy. However, differences were observed by facility type. Participants in ART clinics were older, more likely to be female, and showed higher reactivity (15% vs. 8%) and treatment uptake (96% vs. 83%) than OSS clients. Acceptability was higher in ART clinics than OSS. Conclusions HCVST was both feasible and acceptable in Nasarawa State, with some observed variations by facility type. These findings demonstrate that with differentiated service delivery models and adequate support for linkage, HCVST can increase HCV diagnosis, linkage to care, and treatment among high-risk groups in Nigeria, supporting integration of HCVST into national viral hepatitis elimination strategies.